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REPRODUCTION & GYNAECOLOGY > Cervical Screening and Vulval Pathology > Flashcards

Cervical Screening and Vulval Pathology Flashcards

(43 cards)

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1
Q

Ho do the linings of the ectocervix and the endocervical canal differ?

A

Ectocervix - lined by squamous epithelium (same as vagina)

Endocervical Canal - lined by glandular epithelium

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2
Q

What cells in the squamous lining of the ectocervix proliferate?

A

Basal cells

- the cells mature and move upwards to surface (like in the skin)

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3
Q

What cells does a cervical smear test remove?

A

Mature surface cells of ectocervical lining

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4
Q

Why is there a Transformation Zone in the cervix rather than a squamo-columnar junction?

A 
Location of squamocolumnar junction changes over time
Due to:
- menarche
- Pregnancy
- menopause

=> area between the original SC Junction and the New SC junction is the Transformation Zone

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5
Q

What causes erosion of the endocervical tissue causing it to undergo squamous metaplasia?

A

acidic environment of vagina

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6
Q

What are Nabothian follicles and are these benign or malignant lesions of the cervix?

A
  • dilated endocervical glands
  • form almost polypoid-like structure
  • Benign
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7
Q

What percentage of Cervical Intraepithelial Neoplasia (a precursor to cancer) occurs in the Transformation Zone?

A

90%

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8
Q

What inflammatory pathologies can present in the cervix?

A

Cervicitis

  • often asymptomatic
  • can lead to infertility due to silent fallopian tube damage
  • non-specific acute/chronic inflammation.

Cervical polyp

  • localised inflammatory outgrowth,
  • Cause of bleeding, if ulcerated
  • Not premalignant
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9
Q

What can cause cervicitis?

A

Chemical Irritants

Infection e.g. Chlamydia, Herpes Simplex

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10
Q

What neoplastic pathologies can present in the cervix?

A
  • Cervical Intraepithelial Neoplasia (CIN)
  • Cancer
    => Squamous carcinoma
    => Adenocarcinoma
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11
Q

What is the most important risk factor for development of neoplastic pathology in the cervix?

A

High Risk Human Papilloma Virus (HPV) types
- 16,18 = highest
(31,33,35,45,48…)

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12
Q

What other risk factors exist for CIN and cervical cancer?

A
  • many sexual partners = increased risk of acquiring high risk HPV subtypes
  • younger age of first intercourse/pregnancy
  • long term use of oral contraceptives
  • non-use of barrier contraception
  • Smoking: 3 x risk
  • Immunosuppression
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13
Q

How do genital warts appear on histology?

A
  • thickened “papillomatous” squamous epithelium
  • Cytoplasmic vacuolation
  • Koilocytosis => Nuclear enlargement (2-3x normal size) and Irregularity of the nuclear membrane contour
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14
Q

How does the appearance of CIN differ from that of genital warts?

A
  • Affected epithelium remains flat (unlike wart)

- shows koilocytosis, which can be detected in cervical smears

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15
Q

CIN is graded from 1-3 with Grade 3 being the most severe. What is Grade 3 CIN homologous to?

A

Carcinoma in situ

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16
Q

When does CIN 3 thought to become a cancer on microscopic analysis?

A

When the cells break through the basement membrane to invade the stroma

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17
Q

How long does it usually take for HPV infection to progress to CIN 3, and how long for CIN 3 to progress to cancer?

A

HPV infection to High grade CIN:
=> 6 months - 3 years

High Grade CIN to Invasive Cancer
=> 5 -20 years

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18
Q

What is dyskaryosis and how is this analysed from a smear sample?

Study These Flashcards
A
  • nuclear abnormalities (enlarged and pleomorphic)
  • Nuclear:cytoplasm ratio increase
  • analysed using cytology
19
Q

CIN is asymptomatic and not visible to the naked eye. TRUE/FALSE?

20
Q

Mitotic figures present in mature cells above the basal layer is abnormal and indicates CIN. TRUE/FALSE?

Study These Flashcards
A

TRUE

  • mitotic figures should only be seen in basal layer as this is only dividing layer
  • if mitotic figures are present in mature cells then these are replicating when they should not be
21
Q

CIN grading depends on the severity of what 3 factors?

Study These Flashcards
A
  • Delay in maturation/differentiation
  • Nuclear abnormalities
  • Excess mitotic activity
22
Q

Describe the differences between cytology of CIN 1-3?

Study These Flashcards
A

CIN I

  • Basal 1/3 of epithelium = abnormal cells.
  • Mitotic figures in lower 1/3
  • Surface cells mature, but nuclei abnormal.

CIN II

  • Abnormal cells extend to middle 1/3.
  • Mitoses in middle 1/3
  • Abnormal mitotic figures

CIN III

  • Abnormal cells occupy full thickness of epithelium.
  • Mitoses in upper 1/3.
23
Q

What is the largest risk factor for developing cervical cancer?

Study These Flashcards
A

Not participating in the cervical screening programme

24
Q

How will the cervical screening programme be changing as of March 2020?

Study These Flashcards
A
  • instead of analysing cytology, patients will be directly tested for high risk HPV subtypes
  • If these are present, patients will then go on to have cells analysed by cytology
25
Describe the progression of Stage 1-4 cervical cancer?
Stage 1 - confined to cervix Stage 2 - local spread => vagina/uterus Stage 3 - Spread to pelvic wall Stage 4 - Distant Metastases or bladder/rectal involvement
26
If patients do not attend screening and cervical cancer is not picked up early, what symptoms may they have?
``` - Abnormal bleeding => Post coital => Post menopausal => Brownish or blood stained vaginal discharge => Contact bleeding – friable epithelium ``` - Pelvic pain - Haematuria (not really - just blood staining urine) - Ureteric obstruction / renal failure
27
Describe how squamous cervical cancer normally spreads?
Local - uterine body, vagina, bladder, ureters, rectum Lymphatic - EARLY => pelvic, para-aortic nodes Haematogenous - LATE => liver, lungs, bone
28
What is meant by a well-differentiated tumour?
Completely changed to appear exactly like new cell type (e.g. like squamous epithelium)
29
Some squamous cancers found in the cervix can keratinise. TRUE/FALSE?
TRUE
30
What glandular lesions can occur in the endocervical region?
- cervical glandular intraepithelial neoplasia - from endocervical epithelium - preinvasive phase of endocervical adenocarcinoma - also caused by HPV
31
Screening is less effective for CGIN (glandular lesions of endocervix). TRUE/FALSE?
TRUE - More difficult to diagnose on cervical smear than squamous => Screening less effective
32
Endocervical Adenocarcinoma has a worse prognosis than squamous carcinoma of the cervix. TRUE/FALSE?
TRUE
33
Who is more likely to get endocervical adenocarcinoma?
- Higher Socioeconomic Class - Later onset of sexual activity - Smoking - HPV infection => particularly HPV18.
34
What other abnormalities of the reproductive tract are caused by HPV?
Vulvar Intraepithelial Neoplasia, VIN Vaginal Intraepithelial Neoplasia, VaIN Anal Intraepithelial Neoplasia, AIN ALSO PeIN (Penile Intraepithelial Neoplasia) PaIN (para-anal)
35
What is the difference between vulval intraepithelial neoplasia in younger vs older women?
Young women: often multifocal/ recurrent/ persistent causing treatment problems Older women: greater risk of progression to invasive squamous carcinoma.
36
Vulval intraepithelial neoplasia is associated with what other disease?
Paget's - crusting rash (keratin on surface) - Tumour cells in epidermis, contain mucin. - No underlying cancer, tumour arises from sweat gland in skin
37
What age group usually develop invasive cancers from VIN?
- elderly women - well differentiated - Spread to inguinal lymph nodes (important for prognosis)
38
How is Vulvar Invasive Squamous Carcinoma (derived from VIN) treated?
Surgical treatment – radical vulvectomy and inguinal lymphadenectomy
39
What non-neoplastic diseases can occur in the vulval epithelium?
Lichen Sclerosis Other dermatoses - Lichen planus - Psoriasis
40
Patients with VaIN also have CIN or VIN. TRUE/FALSE?
TRUE
41
Patients with VaIN have much less chance of progressing to vaginal cancer than CIN/VIN do for their respective cancers. TRUE/FALSE?
TRUE
42
Squamous carcinoma is common in what age group?
disease of the elderly
43
Melanoma can rarely appear in the vagina. Describe how this may appear?
Polyp

REPRODUCTION & GYNAECOLOGY (58 decks)

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